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OBJECTIVES: The optimal prosthesis option for aortic valve replacement in adult patients <60 y... more OBJECTIVES: The optimal prosthesis option for aortic valve replacement in adult patients <60 years of age with severe aortic stenosis (AS) remains controversial. The objective was to determine the long-term outcomes of the Ross procedure in this population. METHODS: Between 1990 and 2013, 276 patients aged 18 years and above (mean 40.3 ± 10.6) underwent an elective Ross procedure. Among them, 221 patients had predominant severe AS; these patients form the study group. The Ross procedure was performed either by aortic root replacement (n = 190; 86%) or the subcoronary technique (n = 31; 14%). There were 169 patients with bicuspid valves and 33 redo operations including previous aortic valve repair (n = 6) and replacement (n = 9) for severe AS. Demographic, preoperative, postoperative and longitudinal clinical and echocardiographic data were collected prospectively. The median and mean follow-up were 11.4 years (range: 1–20.1 years) and 10.1 ± 5.9 years, respectively. The follow-up...
Objectives: The optimal prosthesis option for aortic valve replacement (AVR) in adult patients le... more Objectives: The optimal prosthesis option for aortic valve replacement (AVR) in adult patients less than 60 years of age with aortic stenosis remains controversial. Our objective was to determine the long-term outcomes of the Ross procedure in these patients. Methods: Between 1990 and 2013, 278 patients aged 18 years and above (mean 40.3 ± 10.6) underwent elective Ross procedure either by aortic root replacement (96%) or subcoronary technique (4%). Among them, 225 patients had predominant severe aortic stenosis; these patients form the study group. There were 171 patients with bicuspid valves and 34 redo operations, including previous aortic valve repair (n = 6) and AVR (n = 10) for severe aortic stenosis. Demographic, preoperative, postoperative, and longitudinal clinical and
L’anévrisme mycotique de l’aorte abdominale est une infection de la paroi aortique lors d’une bac... more L’anévrisme mycotique de l’aorte abdominale est une infection de la paroi aortique lors d’une bactériémie le plus souvent à point de départ extra-cardiaque. Son pronostic est grave en raison du risque majeur de rupture. Nous rapportons une étude rétrospective à propos de 5 observations de patients d’âge moyen de 40 ans (extrême 15 à 53 ans) présentant des anévrismes mycotiques de l’aorte abdominale sous-rénale. La cure de l’anévrisme a consisté en une résection des tissus infectés associée à une épiplooplastie, le rétablissement de la continuité artérielle a été assuré par un pontage axillo-bifémoral dans tous les cas. La mortalité hospitalière est de 20 %. A long terme, deux patients ont présenté une thrombose tardive de leur pontage dont un a été repris pour revascularisation par pontage aorto-bifémoral à partir de l’aorte thoracique. La revascularisation extra-anatomique doit être considérée comme une méthode satisfaisante dans le traitement des anévrismes mycotiques de l’aorte a...
Interactive CardioVascular and Thoracic Surgery, 2013
Objectives: The optimal prosthesis option for aortic valve replacement (AVR) in adult patients le... more Objectives: The optimal prosthesis option for aortic valve replacement (AVR) in adult patients less than 60 years of age with aortic stenosis remains controversial. Our objective was to determine the long-term outcomes of the Ross procedure in these patients. Methods: Between 1990 and 2013, 278 patients aged 18 years and above (mean 40.3 ± 10.6) underwent elective Ross procedure either by aortic root replacement (96%) or subcoronary technique (4%). Among them, 225 patients had predominant severe aortic stenosis; these patients form the study group. There were 171 patients with bicuspid valves and 34 redo operations, including previous aortic valve repair (n = 6) and AVR (n = 10) for severe aortic stenosis. Demographic, preoperative, postoperative, and longitudinal clinical and
Journal des maladies vasculaires, 2003
Between 1988 and 2001, five patients with mycotic aneurysm of the abdominal aorta underwent surge... more Between 1988 and 2001, five patients with mycotic aneurysm of the abdominal aorta underwent surgery. Extra-anatomical reconstruction with axillo-bifemoral bypass grafting was performed in all patients. The hospital mortality rate was 20%. During the follow-up period two patients presented thrombosis of the axillo-bifemoral bypass, descending aorto-bifemoral bypass was performed in one. Extra-anatomic revascularization is a satisfactory procedure in the treatment of mycotic abdominal aortic aneurysm. The results are acceptable and the prognosis is mainly related to the underlying pathology and the severity of the infection.
Circulation, Nov 23, 2010
European Journal of Cardio-Thoracic Surgery, 2014
OBJECTIVES: The optimal prosthesis option for aortic valve replacement in adult patients <60 year... more OBJECTIVES: The optimal prosthesis option for aortic valve replacement in adult patients <60 years of age with severe aortic stenosis (AS) remains controversial. The objective was to determine the long-term outcomes of the Ross procedure in this population. METHODS: Between 1990 and 2013, 276 patients aged 18 years and above (mean 40.3 ± 10.6) underwent an elective Ross procedure. Among them, 221 patients had predominant severe AS; these patients form the study group. The Ross procedure was performed either by aortic root replacement (n = 190; 86%) or the subcoronary technique (n = 31; 14%). There were 169 patients with bicuspid valves and 33 redo operations including previous aortic valve repair (n = 6) and replacement (n = 9) for severe AS. Demographic, preoperative, postoperative and longitudinal clinical and echocardiographic data were collected prospectively. The median and mean follow-up were 11.4 years (range: 1-20.1 years) and 10.1 ± 5.9 years, respectively. The follow-up was complete in all patients. Kaplan-Meier actuarial survival analysis was performed to assess long-term survival, freedom from reoperation for autograft and/or homograft failure and freedom from autograft valve insufficiency. Cox regression risk analysis was performed to identify factors associated with autograft or homograft reoperations. RESULTS: The perioperative mortality rate was 0.9% (n = 2). The incidence rate of early reoperation for bleeding was 5.9%. The actuarial survival rate at 10 and 15 years following surgery was 92.1 and 90.5%, respectively. Ross-related reoperations occurred in 21 patients during follow-up: autograft dysfunction (n = 9), homograft dysfunction (n = 6) and both (n = 6). The rate of freedom from Ross-related reoperation was 94.7 and 87.7% at 10 and 15 years, respectively. The rate of freedom from reoperation for autograft failure was 97.6 and 91.5%, the rate of freedom from reoperation for homograft failure was 95.7 and 90.8%, and the rate of freedom from moderate or severe autograft regurgitation was 94.1 and 85.6% at 10 and 15 years, respectively. CONCLUSIONS: Compared with available aortic bioprosthetic alternatives in young adults with severe AS, the Ross procedure provides an excellent long-term option for patients with predominant severe AS who seek a durable operation without anticoagulation.
European Journal of Cardio-Thoracic Surgery, 2014
OBJECTIVES: The optimal prosthesis option for aortic valve replacement in adult patients <60 y... more OBJECTIVES: The optimal prosthesis option for aortic valve replacement in adult patients <60 years of age with severe aortic stenosis (AS) remains controversial. The objective was to determine the long-term outcomes of the Ross procedure in this population. METHODS: Between 1990 and 2013, 276 patients aged 18 years and above (mean 40.3 ± 10.6) underwent an elective Ross procedure. Among them, 221 patients had predominant severe AS; these patients form the study group. The Ross procedure was performed either by aortic root replacement (n = 190; 86%) or the subcoronary technique (n = 31; 14%). There were 169 patients with bicuspid valves and 33 redo operations including previous aortic valve repair (n = 6) and replacement (n = 9) for severe AS. Demographic, preoperative, postoperative and longitudinal clinical and echocardiographic data were collected prospectively. The median and mean follow-up were 11.4 years (range: 1–20.1 years) and 10.1 ± 5.9 years, respectively. The follow-up...
Objectives: The optimal prosthesis option for aortic valve replacement (AVR) in adult patients le... more Objectives: The optimal prosthesis option for aortic valve replacement (AVR) in adult patients less than 60 years of age with aortic stenosis remains controversial. Our objective was to determine the long-term outcomes of the Ross procedure in these patients. Methods: Between 1990 and 2013, 278 patients aged 18 years and above (mean 40.3 ± 10.6) underwent elective Ross procedure either by aortic root replacement (96%) or subcoronary technique (4%). Among them, 225 patients had predominant severe aortic stenosis; these patients form the study group. There were 171 patients with bicuspid valves and 34 redo operations, including previous aortic valve repair (n = 6) and AVR (n = 10) for severe aortic stenosis. Demographic, preoperative, postoperative, and longitudinal clinical and
L’anévrisme mycotique de l’aorte abdominale est une infection de la paroi aortique lors d’une bac... more L’anévrisme mycotique de l’aorte abdominale est une infection de la paroi aortique lors d’une bactériémie le plus souvent à point de départ extra-cardiaque. Son pronostic est grave en raison du risque majeur de rupture. Nous rapportons une étude rétrospective à propos de 5 observations de patients d’âge moyen de 40 ans (extrême 15 à 53 ans) présentant des anévrismes mycotiques de l’aorte abdominale sous-rénale. La cure de l’anévrisme a consisté en une résection des tissus infectés associée à une épiplooplastie, le rétablissement de la continuité artérielle a été assuré par un pontage axillo-bifémoral dans tous les cas. La mortalité hospitalière est de 20 %. A long terme, deux patients ont présenté une thrombose tardive de leur pontage dont un a été repris pour revascularisation par pontage aorto-bifémoral à partir de l’aorte thoracique. La revascularisation extra-anatomique doit être considérée comme une méthode satisfaisante dans le traitement des anévrismes mycotiques de l’aorte a...
Interactive CardioVascular and Thoracic Surgery, 2013
Objectives: The optimal prosthesis option for aortic valve replacement (AVR) in adult patients le... more Objectives: The optimal prosthesis option for aortic valve replacement (AVR) in adult patients less than 60 years of age with aortic stenosis remains controversial. Our objective was to determine the long-term outcomes of the Ross procedure in these patients. Methods: Between 1990 and 2013, 278 patients aged 18 years and above (mean 40.3 ± 10.6) underwent elective Ross procedure either by aortic root replacement (96%) or subcoronary technique (4%). Among them, 225 patients had predominant severe aortic stenosis; these patients form the study group. There were 171 patients with bicuspid valves and 34 redo operations, including previous aortic valve repair (n = 6) and AVR (n = 10) for severe aortic stenosis. Demographic, preoperative, postoperative, and longitudinal clinical and
Journal des maladies vasculaires, 2003
Between 1988 and 2001, five patients with mycotic aneurysm of the abdominal aorta underwent surge... more Between 1988 and 2001, five patients with mycotic aneurysm of the abdominal aorta underwent surgery. Extra-anatomical reconstruction with axillo-bifemoral bypass grafting was performed in all patients. The hospital mortality rate was 20%. During the follow-up period two patients presented thrombosis of the axillo-bifemoral bypass, descending aorto-bifemoral bypass was performed in one. Extra-anatomic revascularization is a satisfactory procedure in the treatment of mycotic abdominal aortic aneurysm. The results are acceptable and the prognosis is mainly related to the underlying pathology and the severity of the infection.
Circulation, Nov 23, 2010
European Journal of Cardio-Thoracic Surgery, 2014
OBJECTIVES: The optimal prosthesis option for aortic valve replacement in adult patients <60 year... more OBJECTIVES: The optimal prosthesis option for aortic valve replacement in adult patients <60 years of age with severe aortic stenosis (AS) remains controversial. The objective was to determine the long-term outcomes of the Ross procedure in this population. METHODS: Between 1990 and 2013, 276 patients aged 18 years and above (mean 40.3 ± 10.6) underwent an elective Ross procedure. Among them, 221 patients had predominant severe AS; these patients form the study group. The Ross procedure was performed either by aortic root replacement (n = 190; 86%) or the subcoronary technique (n = 31; 14%). There were 169 patients with bicuspid valves and 33 redo operations including previous aortic valve repair (n = 6) and replacement (n = 9) for severe AS. Demographic, preoperative, postoperative and longitudinal clinical and echocardiographic data were collected prospectively. The median and mean follow-up were 11.4 years (range: 1-20.1 years) and 10.1 ± 5.9 years, respectively. The follow-up was complete in all patients. Kaplan-Meier actuarial survival analysis was performed to assess long-term survival, freedom from reoperation for autograft and/or homograft failure and freedom from autograft valve insufficiency. Cox regression risk analysis was performed to identify factors associated with autograft or homograft reoperations. RESULTS: The perioperative mortality rate was 0.9% (n = 2). The incidence rate of early reoperation for bleeding was 5.9%. The actuarial survival rate at 10 and 15 years following surgery was 92.1 and 90.5%, respectively. Ross-related reoperations occurred in 21 patients during follow-up: autograft dysfunction (n = 9), homograft dysfunction (n = 6) and both (n = 6). The rate of freedom from Ross-related reoperation was 94.7 and 87.7% at 10 and 15 years, respectively. The rate of freedom from reoperation for autograft failure was 97.6 and 91.5%, the rate of freedom from reoperation for homograft failure was 95.7 and 90.8%, and the rate of freedom from moderate or severe autograft regurgitation was 94.1 and 85.6% at 10 and 15 years, respectively. CONCLUSIONS: Compared with available aortic bioprosthetic alternatives in young adults with severe AS, the Ross procedure provides an excellent long-term option for patients with predominant severe AS who seek a durable operation without anticoagulation.
European Journal of Cardio-Thoracic Surgery, 2014